A preliminary morphometric magnetic resonance imaging study of regional brain volumes in body dysmorphic disorder

Morphometric magnetic resonance imaging (MRI) was used to compare regional brain volumes in eight women with body dysmorphic disorder (BDD) and eight healthy comparison subjects. The BDD group exhibited a relative leftward shift in caudate asymmetry and greater total white matter vs. the comparison group. Findings with respect to the caudate nucleus are consistent with both the conceptualization of BDD as an obsessive-compulsive spectrum disorder, and the 'striatal topography model' of obsessive-compulsive disorders.     

Between parent and child: negotiating cancer treatment in adolescents

Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital, founded the Kenneth B. Schwartz Center. The Schwartz Center is a non-profit organization dedicated to supporting and advancing compassionate health care delivery, which provides hope to the patient, support to caregivers, and sustenance to the healing process. The center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members. Cancer in adolescents presents an extra dynamic of psychosocial complexity. The case of a 19-year-old woman with acute myelocytic leukemia is discussed. Her disease was refractory to allogeneic transplantation, and she died with severe graft-versus-host disease. Ms. P and her mother established very different relationships with the team which supported them through the transitions in her care, and Ms. P was able to die at home, with hospice care. The personal connection with the team enabled a degree of positive adjustment through the nightmare of loss. The epidemiology of cancer in adolescents and paradigms of care are reviewed. Psychosocial aspects of adolescence, opportunities for personal growth and support, and the challenge of end-of-life care are discussed.     

Volatile anaesthetics may be the main cause of early but not delayed postoperative vomiting: a randomized controlled trial of factorial design

Background. Despite intensive research, the main causes of postoperativenausea and vomiting (PONV) remain unclear. We sought to quantifythe relative importance of operative, anaesthetic and patient-specificrisk factors to the development of PONV. Methods. We conducted a randomized controlled trial of 1180children and adults at high risk for PONV scheduled for electivesurgery. Using a five-way factorial design, we randomly assignedsubjects by gender who were undergoing specific operative procedures,to receive various combinations of anaesthetics, opioids, andprophylactic antiemetics. Results. Of the 1180 patients, 355 (30.1% 95% CI (27.5–32.7%))had at least one episode of postoperative vomiting (PV) within24 h post-anaesthesia. In the early postoperative period (0–2h), the leading risk factor for vomiting was the use of volatileanaesthetics, with similar odds ratios (OR (95% CI)) being foundfor isoflurane (19.8 (7.7–51.2)), enflurane (16.1 (6.2–41.8))and sevoflurane (14.5 (5.6–37.4)). A dose–responserelationship was present for the use of volatile anaesthetics.In contrast, no dose response existed for propofol anaesthesia.In the delayed postoperative period (2–24 h), the mainpredictors were being a child (5.7 (3.0–10.9)), PONV inthe early period (3.4 (2.4–4.7)) and the use of postoperativeopioids (2.5 (1.7–3.7)). The influence of the antiemeticswas considerably smaller and did not interact with anaestheticor surgical variables. Conclusion. Volatile anaesthetics were the leading cause ofearly postoperative vomiting. The pro-emetic effect was largerthan other risk factors. In patients at high risk for PONV,it would therefore make better sense to avoid inhalational anaesthesiarather than simply to add an antiemetic, which may still beneeded to prevent or treat delayed vomiting. Br J Anaesth 2002; 88: 659–68     

Human fetal bone development: histomorphometric evaluation of the proximal femoral metaphysis

Quantitative data on metaphyseal bone histology during early human development are scarce. In the present study the proximal femoral metaphysis of 35 fetuses and newborns (gestational age 16–35 weeks) was analyzed by histomorphometry. Averaged over the entire metaphyseal area, the relative amount of bone and cartilage was higher in the third compared to the second trimester. Osteoid thickness increased with gestational age, whereas indices of bone resorption decreased. The relative amount of cartilage decreased with increasing distance from the growth plate, whereas the relative amount of bone increased. This was due to trabecular thickening, which occurred at an estimated rate of 3 μm/day in areas close to the growth plate. Despite this rapid rate of net bone gain, osteoid indices were relatively low, indicating that mineralization occurred very rapidly after bone deposition. These observations suggest that modeling, not remodeling, is the predominant mechanism responsible for the development of femoral metaphyseal cancellous bone in utero.     

反应停治疗难治性多发性骨髓瘤25例

1临床资料我院2001-02/2004-01接受2个疗程卡氮芥 环磷酰胺 马法兰 泼尼松 长春新碱或2个疗程长春新碱 阿霉素 地塞米松方案化疗无效或复发的难治性多发性骨髓瘤患者25(男16,女9)例,年龄42～80(中位年龄57.2)岁.单用反应停口服治疗,起始剂量200 mg/d,如无不良反应,每周增加100 mg,根据患者耐受情况,最高剂量为600 mg/d,3 mo为1疗程.服药期间禁止使用糖皮质激素类药物及细胞毒药物.     

Effects of locally applied transforming growth factor-beta1 on distraction osteogenesis in a rabbit limb-lengthening model

In this study we tested the effect of locally applied transforming growth factor-beta1 (TGF-beta1) on distraction osteogenesis in rabbits. A total of 61 rabbits were studied. Seven days after tibial osteotomy, distraction was started at a rate of 0.25 mm/12 h for 3 weeks. Starting with distraction, TGF-beta1 was applied in four different dosages (0, 10, 20, and 40 ng/day) at the site of osteotomy through a catheter connected to a subcutaneously implanted miniosmotic pump. Rabbits were killed at the end of the distraction period or 3 weeks later, and histological, densitometric, and biomechanical parameters were assessed. TGF-beta1 treatment had no detectable effect on bone mineral density or histologically determined bone volume in the distraction gap but it increased the amount of fibrous tissue in the callus region. Load to failure in uniaxial tension tended to be lower in TGF-beta1-treated animals. In conclusion, TGF-beta1 treatment during distraction osteogenesis did not have a beneficial effect in this model.     

Nurses' perceived barriers to the implementation of a Fall Prevention Clinical Practice Guideline in Singapore hospitals

Background  

Theories of behavior change indicate that an analysis of barriers to change is helpful when trying to influence professional practice. The aim of this study was to assess the perceived barriers to practice change by eliciting nurses' opinions with regard to barriers to, and facilitators of, implementation of a Fall Prevention clinical practice guideline in five acute care hospitals in Singapore.